The NEM Stress Continuum Response – Part 2

By: Michael Lam, MD, MPH; Justin Lam, ABAAHP, FMNM

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Stage 3 – NEM Response Exhaustion:

Dysmenorrhea is one of the signs that our stress continuum defense system starts to break downUnrelenting burden resulting in metabolic dysregulation and HPA axis overdrive cannot go on forever. Our metabolic, detoxification and inflammation circuits have exceeded their functional capacity in this stage. They are overwhelmed and become dysfunctional. In other words, our stress continuum defense system starts to break down from overwork.

If stress is not resolved or at least put under control, the entire NEM response enters the exhaustion phase. The body enters stage 3 of adrenal fatigue from a neuroendocrine perspective. Metabolically, the body enters a state of metabolic exhaustion. This stage is perhaps the most dangerous because the velocity of decline can be fast. Fatigue crashes start to be more debilitating as both neuroendocrine and metabolic problems surfaces.

From the neuroendocrine perspective, the body enters a state of hormonal dysregulation beyond the HPA axis. In the female, the OAT axis becomes disturbed. In the male, the AT hormone axis can be damaged. The four phases of adrenal exhaustion (also called neuroendocrine exhaustion or stage 3 adrenal fatigue) take their toll on the body as vitality reduces. Symptoms of neuroendocrine derangement become more severe, including dysmenorrhea, brain fog, anxiety, and reactive hypoglycemia. Our autonomic nervous system will start to flood the body with norepinephrine and adrenaline to prepare us for the “flight or fight” response. The reproductive system will slow down as energy is channeled towards our brain to keep us on full alert in preparation of surviving the worst case scenario. Such neuroendocrine response, utilizing the hormone, cardionomic and neuroaffective circuits, becomes overpowering and overshadows the still ongoing metabolic response. It rises to the forefront – similar to the front line marines landing to establish a beachhead as the battle begins. Symptoms becomes more severe, with reactive hypoglycemia, anxiety, insomnia, and increasing fatigue becoming most bothersome.

Metabolically, the body experiences reactive hypoglycemia, food sensitivities, frequents infection, bloating, and irritable bowel – all signs of a unhappy metabolic system within.

Reactive sympathetic overtone and reactive sympatho-adrenal response rule the day as the body comes under full control of the catecholamine – the last resort. Metabolically, metabolic dysregulation of earlier stages progresses now to metabolic exhaustion. The body is unable to keep up with the detoxification process; it becomes more and more inflamed as the progression worsens. Reactive metabolite overload becomes a problem, and the body enters a reactive metabolite response that can be extremely harmful and negative.

Reactive metabolite response, along with reactive sympatho-adrenal response form the hallmark of NEM exhaustion. The body is in a stage of disrepair. Regulatory pathways designed to be self healing have failed. The body is internally in shambles.

These are the body’s further warning signs for us to take action. This is the time where physician’s help is often sought and sufferers starts to lose faith in the healthcare system. Most sufferers are sent home after normal laboratory test and multiple physician visits. Those who complain frequently are put on anti-depressants, stimulatory hormonal replacement, and sleeping medications.

Stage 4 – NEM Stress Continuum Response Failure:

Unwanted symptoms can be results of the stress continuumBoth the metabolic and the neuroendocrine components of the NEM stress continuum response capitulate and surrender. No longer able to restore equilibrium, the body resorts to the only strategy it knows for survival – reducing energy expenditure with the exception of key organs such as the brain. Reproduction and hormonal regulation becomes trivial compared to the immediate need to provide energy for survival at the most basic vegetative state. The body is in a state of disarray. Frequent heart palpation , temperature intolerance, amenorrhea, electrolyte instability, dizziness, breathlessness, dehydration, electrolyte imbalance, severe insomnia, panic attacks grip the body and refuses to let go.

As the neuroendocrine system responses capitulate, the metabolic circuits shutdown process begins as well. All efforts are directly towards survival and conservation of energy. The body starts to lose weight and enters a catabolic state. The gut slows down to avoid unnecessary energy expenditure. Reactive toxic metabolite buildup continues unabated, leading to severe reactive metabolite response that can render the sufferer bedbound. Ambulatory care is needed for daily living.

The body ultimately progresses to a brittle state of vegetative function. This is the state commonly known as the “living dead”.

NEM Response Stage Neuroendocrine Component Response Activity Metabolic Component Response Activities Adrenal Fatigue Syndrome Association
Stage 1: Activation neuroendocrine activation metabolic auto-regulation alarm reaction
Stage 2: Overdrive HPA axis overdrive metabolic dysregulation resistance response
Stage 3: Exhaustion autonomic nervous system overdrive, reactive sympathetic overtone (RSO) and reactive sympatho-adrenal response (RSR) metabolic exhaustion, reactive metabolite overload (RMO) and reactive metabolite response (RMR) adrenal exhaustion (neuroendocrine exhaustion)
Stage 4: Failure neuroendocrine capitulation metabolic shutdown adrenal failure (neuroendocrine failure)

Stage Dependent Symptoms Summary

Now that you understand how the body may switch gears in its response to stress progression, we will take a look at how symptoms of each circuit varies and reflect such switches. We hope you can that there is the logical flow behind the symptoms, and that the body is much smarter than we think.

The following table breaks down the six circuit response to stress with their corresponding symptoms and organs involved as NEM stress continuum response progresses through the stages.

Stress Response Circuit Primary Systems and Organs Involved NEM Response stress Continuum Activation (stage 1) and Overdrive (stage 2) NEM Response Stress Continuum Exhaustion (stage 3) and Failure (stage 4)
Hormone Adrenal-Reproductive-Thyroid estrogen dominance, low libido, premenstrual syndrome (PMS), endometriosis, polycystic ovary syndrome (PCOS), amenorrhea, erectile dysfunction low cortisol output, thyroid resistance, brittle adrenal
Metabolism Thyroid-Pancreas-Liver metabolic syndrome, sugar cravings, salt cravings, dyslipidemia, weight gain carbohydrate dependency, carbohydrate intolerance, catabolic state, liver congestion, organ resistance, reactive hypoglycemia
Detoxification Liver-ECM-Immune hypersensitivity to drugs and supplements, paradoxical reactions, sensitivity to food, pain of unknown origin electromagnetic field (EMF) sensitivity, paradoxical reaction ,chemical sensitivities, recurrent crashes, retoxification reaction, paradoxical reaction, reactive metabolite overload
Inflammation Immune-Microbiome-GI food sensitivities, leaky gut, irritable bowel syndrome (IBS), recurrent infections, Epstein-Barr virus (EBV) recurrent and stealth infection, autoimmune disorders, , systemic candida, small intestinal bacterial overgrowth (SIBO), inflammatory bowel disease (IBD)
Neuroaffective GI-CNS-ANS mood swings, anxiety, sleep onset insomnia (SOI), sleep maintenance insomnia (SMI), stress intolerance adrenaline rushes, panic attacks, depression, neurotransmitter imbalances
Cardionomic ANS-Heart-Adrenal heart palpitations, tachycardia, sub-clinical postural orthostatic tachycardia syndrome (POTS) shortness of breath, breathlessness, premature ventricular contractions (PVC), atrial fibrillation, clinical POTS

Stress continuum responses vary from person to personThe above table listing is by no means comprehensive or all inclusive. They serve only as general reminders of our body’s systemic and comprehensive approach to handling stress from a functional perspective. The body has multiple avenues of alerting us of danger within. Different signs and symptoms are activated depending on the stage. As stress increases, symptoms worsens. Because each person is unique, no two people respond identically. There is much overlap, depending on the body state of resilience and constitution.

From afar, it is clear that the body’s way to handle stress is comprehensive and holistic in nature. Multiple systems and organs are activated simultaneously because the body does not take chances when it comes to stress. Modulation is automatic (by way of self regulation) through intensity and frequency of activation. Depending on the degree of stress, the body in its infinite wisdom will decide the appropriate course of action and timing. Each person is different. What happens to one person is unlikely to replicate in another, although some general recurrent trends can be seen from our clinical experience.

It is also very important not to jump to conclusions too quickly and make rash decisions based on the above table alone. Many other conditions can present with similar symptoms. A person who is anemic may present with fatigue and low energy, for example. This is why a thorough work up should be carried out and no stone unturned.

Variations on a Theme

Many signs and symptoms of NEM response activation (stage 1) and overdrive (stage 2) carry through to NEM response exhaustion (stage 3) and failure (stage 4). As more severe symptoms surface, milder ones tend to take a back seat. Some symptoms appear in reversed order from those shown in the table. For example, they may have severe palpitations right off the bat. Still others sufferers have some signs and symptoms of each column without a clear and predictable order or sequence. So much depends on the body in real time as it deals with daily stress. Some symptoms can wax and wane with time. For example, panic attack may be followed by calm and relaxation. Such roller coaster rides is not unusual. It reflects the body’s continuous and never ending attempts to rebalance itself, though the weaker the body the higher chances of failure.

The stress continuum can cause heart palpitationsMost phase progress and symptoms get worse with time, such as hypersensitivity to drugs and supplements. The weaker the body, the greater the risk. However, the general trend is one towards massive decompensation, as both components of the NEM stress continuum response become dysfunctional as stage 4 approaches, although not necessarily to the same degree – as we shall discuss further in later chapters.

Knowing the key presenting symptoms and component dominance of each stage of the NEM stress response progression helps us to better understand how the body handles stress and what we can expect.

The first step in any healing process is to understand the problem on hand. Knowing the NEM stress continuum stress response perspective and how the body switches its responsibility from one component to another as stress increases sheds light on and helps us see. What appeared to be convoluted symptoms is actually a systematic approach by the body – using the tools it has – to begin the process of self healing.

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© Copyright 2017 Michael Lam, M.D. All Rights Reserved.

Stress continuum
Stress continuum